A comparison of single and intersectional social identities associated with discrimination and mental health service use

Data from the 2014 Adult Psychiatric Morbidity Survey in England

Datos Bibliográficos

ID8070698
AutoresRebecca Rhead (0000-0002-5863-604X, autor de correspondencia), Charlotte Woodhead (0000-0002-5545-6238), Gargie Ahmad (0000-0003-0988-7587), Jayati Das-Munshi (0000-0002-3913-6859), Shea Mcmanu (0000-0003-2711-0819), Sally McManus, Stephani L Hatch (0000-0001-9103-2427)
Año2022
Volumen57
Número10
Páginas2049-2063
Fecha de publicación2022-03-07
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaSocial Psychiatry and Psychiatric Epidemiology (JOURNAL)
Identificadores de la revistaISSN: 0933-7954 • E-ISSN: 1433-9285
EditorialSpringer Science+Business Media (PUBLISHER • DE)
DOI10.1007/s00127-022-02259-1
PMID35254450
OpenAlexW4220744411
IdiomaEN
Citas recibidas7
Referencias citadas53

Inequities in mental health service use (MHSU) and treatment are influenced by social stratification processes linked to socially contextualised interactions between individuals, organisations and institutions. These complex relations underpin observed inequities and their experience by people at the intersections of social statuses. Discrimination is one important mechanism influencing such differences. We compared inequities in MHSU/treatment through single and intersectional status analyses, accounting for need. We assessed whether past-year discrimination differentially influences MHSU/treatment across single and intersecting statuses. Data came from a population survey (collected 2014–2015) nationally representative of English households ( N = 7546). We used a theory and datadriven approach (latent class analysis) which identified five intersectional groups in the population comprising common combinations of social statuses. Single status analyses identified characteristics associated with MHSU/treatment (being a sexual minority (adjusted odds ratio (AOR) 1.65 95% CI:1.09-2.50), female (AOR 1.71, 95% CI:1.45–2.02), economically inactive (AOR 2.02, 95% CI:1.05–3.90), in the most deprived quintile (AOR 1.33, 95% CI:1.02–1.74), and Black (AOR 0.36 95% CI:0.20–0.66)). Intersectional analyses detected patterns not apparent from single status analyses. Compared to the most privileged group (“White British, highly educated, employed, high social class”), “Retired White British” had greater odds of MHSU/treatment (AOR 1.88, 95% CI:1.53-2.32) while “Employed migrants” had lower odds (AOR 0.39, 95% CI:0.27–0.55). Past-year discrimination was associated with certain disadvantaged social statuses and greater MHSU/treatment but—except for sexual minorities—adjusting for discrimination had little influence using either analytic approach. Observing patterns only by single social statuses masks potentially unanticipated and contextually varying inequities. The latent class approach offers policy-relevant insights into patterns and mechanisms of inequity but may mask other key intersectional patterns by statuses less common or under represented in surveys (e.g. UK-born ethnic minority groups). We propose multiple, context-relevant, theory-driven approaches to intersectional understanding of mental health inequalities.

Mental health · Mental health service · Psychiatric epidemiology · Psychiatry · Public health · Medicine · Mental Health Treatment and Access · Migration, Health and Trauma · Psychology · Racial and Ethnic Identity Research · Epidemiology